Caregiver Taxes

With a few of President Obama's cabinet nominations running into some tax issues (issues such as sort of not paying them), questions about tax requirements for household help are being asked.

Basically, just as companies must provide for payroll taxes for employees (the company chips in for part of the taxes along with the employee) to pay for Social Security taxes, Medicare taxes and Unemployment insurance taxes, the same requirement holds true for household employees.  This is often referred to as the "nanny tax" but if you have hired a senior caregiver or even an ongoing gardener, you must provide for these taxes.

Keep in mind that this is also a benefit for the worker, as when they go to retire, they will be able to collect a Social Security check and if they are out of work, they will be able to collect an Unemployment benefit check.  All of these laws were set-up to protect employees.

Another advantage of hiring a Senior Home Care Agency is that the agency takes care of all of these taxes (and you have the added bonus of Worker's Compensation Insurance to cover any caregiver injuries - if you were hiring the caregiver directly and an injury occurred, the senior would be liable and the Caregiver could ask the senior to pay for all medical expenses and ongoing care needs - all of the senior's personal assets would be fair game to cover these costs - you know, yummy stuff for the ambulance chasing lawyers.  Worker's Compensation protects senior's assets if an injury occurs).

Failing to pay these taxes is considered tax fraud.  It is also important to make sure the Caregiver is legal to work and in instances where senior's may have memory loss, it is vital to make sure the Caregiver has passed a multi-state criminal background check and has active management in place. Senior Home Care Agencies go the extra mile to take care of all of these issues to provide a quality caregiver.

Not paying taxes for a caregiver will also cause the caregiver hardship, including being unable to build a credit history because they cannot verify their employment and pay.

The Supreme Court is also hearing a case regarding illegal workers who use fake identity's because they do not have a social security card of their own and this issue has spiraled into a case of identity theft.

What is the old saying:  penny-wise but pound-foolish?  Truly, the few dollars someone thinks they are saving by not providing for a Caregiver's taxes really are a huge loss - a loss in insurance protection, and social security, Medicare and unemployment insurance for the Caregiver.

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New Laser Treatment Assists with Stroke Recovery

An experimental stroke treatment that sends laser beams into the brain may help patients with milder strokes lessen their crippling effects, based on the results of a recent clinical trial.  Seniors who suffer strokes usually always require a senior caregiver to assist them during the first year of recovery as they participate in therapy to regain their abilities.

Patients with moderate to moderately severe strokes improved after receiving the laser treatment called the NeuroThera Laser System administered in Carlsbad, California.

Stroke is the No. 3 cause of death in the United States and a leading cause of disability.  Usually seniors who suffer a stroke will have paralysis on either the right or left side of the body, depending on the type of stroke.  Movement can return if the senior participates in intense physical therapy, speech therapy and occupational therapy the first year following the storke.

There is one effective treatment for stroke which involves a clot-busting drug and must be administered within 3 hours of the stroke.  "We need something for patients who come in later than that," says Dr. Justin Zivin of the University of California San Diego, who led the study funded by PhotoThera.

The results of the study were presented at the American Stroke Association meeting. 

Caregivers and seniors interested in learning more can contact the American Stroke Association.

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Medicare Senior Caregivers

This is a question which constantly comes up when a senior needs care services:  Does Medicare pay for a caregiver to provide senior care services in the home?

The reason there is much confusion around this is because Medicare will sometimes pay for what is called "skilled care", provided by a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist (OT), Speech Therapist (ST).  And Medicare will provide these skilled care providers to visit a senior in their home.  A doctor must approve and prescribe the services and for the care to continue, the senior must show improvement (the idea is that this is short-term therapy to improve a condition, especially after a stroke or hip replacement, for example).

The services may be for as many as 3 visits per week but usually a R.N. is only approved if there is an open wound or medications such as shots must be managed and performed by a R.N.

Medicare's skilled home care does not provide for a Certified Nursing Aide or Companion Caregiver.  These services must be paid for privately or through long-term care insurance, unless a senior has started hospice care, which can provide for a Certified Nursing Aide to visit. , ,

Hiring a Caregiver

When a senior needs extra assistance with their care, because of memory loss, an age-related illness or mobility issues, it becomes necessary to evaluate the best way to provide for the care needs.

The senior care industry refers to these basic care needs as "Activities of Daily Living".  This includes assisting with walking, bathing, toileting and meals.  Nursing Aides and Home Health Aides (each state sets requirements for certification for nursing assistants) are trained to properly provide for senior care needs.  Certification classes usually take 4 to 8 weeks (depending on if it is a part-time or full-time program).  Nursing facilities and hospitals are usually required to have a minimum level of certified nursing assistants on staff based on the number of residents and patients.  Senior Home Care Agencies may staff companion caregivers, as well as nursing aides, depending on the care needs of the senior.

It is important to consider the toll caregiving will take on a spouse or relative.  The physical work required can be substantial and when this is combined with the need to interact with a loved one as a caregiver, the relative can quickly become exhausted and sometimes even depressed.  This is because they are most likely missing out on many of their own daily activities which they now no longer have the time to enjoy.

Many families have told me that hiring a professional caregiver was the best decision they ever made.  The cost is really minimal when you consider that it will allow relatives to spend quality time with their loved one.  Many times the health of a spouse who is performing the duties of caregiving will also decline significantly.  Caregiving is not easy work.  However, it is a little easier when the person performing the care is not a relative or friend and is able to come to work refreshed and leave to go back to their own life.

Caregiverlist does provide quality standards for Senior Home Care Agencies who provide information on their rates and services for our users and you can learn more about the benefits of hiring a senior home care agency from our home page.

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Computerization of Health Records Benefits Seniors

President Obama's stimulus bill has passed and now we must hope that it is implemented with some oversight and accountability (the same accountability we want the banks and others receiving bail out dollars to uphold).

As with all bills that pass the House and Senate, this one too will include many items that cannot please all of us.  But one item I am happy about in the Economic Stimulus bill, and think all seniors and caregivers should celebrate, is this one:

"Making the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized."

Many seniors and their family members have walked into the office of a new doctor - usually a specialist for a new diagnosis such as cancer, Alzheimer's Disease or Parkinson's Disease, only to find they must fill out pages and pages of paperwork to provide information about their medical history and insurance.  And we are the country that invented the internet?  We can drive past a toll booth without tossing a dime into the basket because of technology and we can pay all of our bills with a few clicks on a computer.  But walk into a hospital and they have no way to access your medical records, no way to find out what medications you are taking and no idea what Medicare insurance plan you are on.

It is time for our medical care to get up to speed with technology.  It is possible to do this in a safe and secure way (we transfer millions of dollars a day from one bank account to another via online bill payment).

This seems especially important knowing the senior population will more than double within the next 20 years.  With many industries already communicating information via cell phones, it is time for health care to at least be able to communicate via computers in preparation for a wired society.  This will be a massive benefit for seniors and their family members who often do not live in the same city and need a way to monitor the care.

You may learn more about the health care initiatives included in the stimulus plan on the White House website.  Definitely check in with your local Congressman and Senator to share any concerns you may have with them.  Corporations know that when you track all of your activity, you increase profitability and performance ---- definitely healthcare will benefit in many ways beyond just convenience by the computerization of medical records.

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Caring for the Caregiver

Many times when a family member develops medical conditions which require extra care, relatives will step in to assist with caregiving.  Then, either because the care needs progress or becasue the family members must go back to work, it becomes necessary to hire a professional caregiver.

Regardless of whether the caregiver is a paid professional or a family member, it is important to consider the care needs of the Caregiver in order to have a successful care relationship.

What is the number one injury for caregivers?  Back injuries.  Just as many Registered Nurses suffer back injuries, so do caregivers.  This is because transfers from bed to wheelchair to toilet can become more complicated when a senior does not feel well or is suffering from memory loss.

Senior Home Care Agencies provide professionally managed caregivers which includes providing for a daily routine for the care and necessary insurance coverages (which means Worker's Compensation insurance covers any back injuries).

Make sure you talk to your Caregiver about any specific needs or requests they may have to make sure they are able to provide quality senior care.  Remember, caregiving can be emotionally and physcially exhausting so just taking the time to ask your caregiver how they are doing can make all the difference in the world.

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Certified Nursing Aide

One of the first questions a senior will ask when needing additional care services is:  what duties does a Certified Nursing Aide perform?

My answer is always that the Certified Nursing Aide is the person who performs the "hands-on" care in a nursing home or in hospitals.

The department of public health in each state creates their own nursing aide certification guidelines.   Schools must receive approval to offer a Certified Nursing Aide program and nursing aides working in licensed nursing facilities must be certified.

There are many little details for providing care which can make a huge difference in the quality of the care - nursing aides learn these details as a student in a nursing certification program.

Skills include:  transfers, bathing, dressing, bed pan and catheter care, range of motion exercises, checking vital signs, decubitus ulcer care (bed sores), feeding tube, oxygen tank, hearing aide care, understanding age-related medical conditions and how to interact with a variety of patient personalities (including combative patients).  Making sure sanitary conditions are always maintained are also taught.

Tuition for Certified Nursing Aide training is usually from $500 to $1,000 and many times reimbursement is available through employee programs at nursing centers and hospitals or through city or state incentive programs.

Harold Washington College, a city community college in Chicago, Illinois, charges a $629 tuition fee for their Certified Nursing Aide program.  The Spring semester runs from January 19th and runs for 12 or 13 weeks depending on if it is the day or evening program.  The day program meets Mondays and Wednesdays from 8am to 4pm and the evening program meets Thursdays and Fridays from 4pm to 9pm.

Upon completion of the course, students take the state exam and then may begin working as a Certified Nursing Aide.

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January Unemployment at 7.6% but not for Caregivers

Although the unemployment rate for January has been reported as 7.6%, the good news is that jobs actually increased in the healthcare industry. 

Medicare does not provide for longterm care in a nursing home and because of this, more and more seniors are making the decision to receive one-to-one care by their own professionally managed caregiver at home, rather than rehabilitating from a stroke or hip replacement in a nursing center which may often only provide one nursing aide for every 12 to 15 senior patients.  This prevents the aid from being able to adequately interact and motivate each elderly patient adequately, especially if one patient has a mishap which requires more time. 

In fact, staffing is sometimes inadequate enough in many nursing homes that even those seniors who are rehabilitating in the nursing center while Medicare is paying for their care will hire their own private senior caregiver to assist them. 

Working as a senior caregiver or Certified Nursing Aide or Home Health Aide will pay between $8.00 and $16.00 per hour, depending on what part of the U.S.A. you live in.  In addition, you receive professional training and benefits.  Companion care may not require formal training beyond what a senior care company provides and usually pays 50% to 100% more than minimum wage.

In addition, senior caregiving delivers a fulfilling career, as you know you truly made a positive difference for someone when you go home at the end of the day.  As caregiving sometimes require 24-hour around the clock staffing, there are many opportunities for weekend and evening hours for those who are seeking extra income or a part-time job while studying for a professional career.  Many times nurses and social workers will work as companion caregivers while in school studying for their prerequisites for nursing school or while an undergrad.

Caregiverlist's Career Center provides information about working as a caregiver and connects applicants with hiring senior care companies in their area. You can also read stories from other caregivers to learn about their experiences working as a senior caregiver.


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Nursing Home Inspections and Nursing Home Violations

The government has been advertising the website to let seniors know the nursing home inspection reports are available online (they also allow other websites to download this information and Caregiverlist also provides it).  I have been hearing the ads on NPR and elsewhere.

The nursing home inspection reports are a nice starting point  for seniors and their family members when evaluating a nursing facility for a short or long-term nursing stay.  But it is important to realize that these nursing home inspections are only performed once every 15 months.  Ask any Certified Nursing Aide who has worked at a nursing home (working at a hospital or nursing home is required as part of their certification training) and they will tell you that most nursing homes have an alert "code" that goes out when the nursing home inspectors walk in the door - - - it could be just announcing on the P.A. that "Minerva is on line 1".  This means everyone is on their best behavior.  It reminds me of elementary school when parents sat in on the classroom - even the bullies were nice to everyone on those days, including the teacher.

In addition to the inspections only being made every 15 months,  the nursing home violations are not included in the inspection report, and, actually, this is the information you really need to know when evaluating a nursing facility. 

If you really want to make sure you are going to be moving a senior into a quality nursing home, the best way to find out the quality of the care is to find out the number of nursing aides on staff per number of beds and to talk to the staff.  In addition, find out the monthly nursing home violation report in your state.  As you'll see from the June, 2008, violations in Illinois, many of the violations most likely happen because there just aren't enough caregivers to manage problem residents and to assist with bed sore management.

This is why more seniors are opting for care in the home by a one-on-one caregiver.  Senior Home Care Agencies provide in-home care for a cost of between $16 - $28 per hour, depending on what part of the country you live in, and this fee provides for all the payroll taxes, insurance protection and active management of the caregiver.

Nursing Home Violations For The Month Of June 2008

SPRINGFIELD, Ill – The Illinois Department of Public Health today announced the following type “A” violations of the Nursing Home Care Act were cited during the month of June. An “A” violation, which is the most serious licensure violation imposed by the state, pertains to a condition in which there is a substantial probability that death or serious mental or physical harm will result.

The statement of violation for each facility can be obtained by clicking on the facility's name.

Alden Alma Nelson Manor, a 268-bed skilled facility located at 550 S. Mulford Avenue, Rockford, has been fined $32,500 and notified of license revocation for failure to prevent and protect residents from abuse. Three residents were physically attacked by another resident. The facility has requested a hearing on the Department’s action. A status was held February 26 and settlement negotiations are underway.

All American Nursing Home, a 144-bed skilled and intermediate care facility located at 5448 N. Broadway Street, Chicago, has been fined for failure to maintain a sanitary kitchen and ensure proper food handling to prevent hazardous food borne illnesses. Kitchen staff was observed preparing food without washing hands or using gloves. The facility requested a hearing on the Department’s action. A hearing was held and the facility paid $1,200.

Allen Court, a 16-bed intermediate care facility for the developmentally disabled located 1650 E. Main Street, Clinton, has been fined $20,000 for failure to implement its own policies to prevent neglect of a resident. Staff failed to provide a thorough assessment of the resident’s symptoms and did not provide immediate medical attention after a fall. The facility has requested a hearing on the Department’s action. A status in the case was held February 25.

Belhaven Nursing & Rehab Center, a 221-bed skilled care facility located at 11401 S. Oakley Avenue, Chicago, has been fined $30,000 for failure to provide necessary care and services to residents to prevent pressure sores and treat new sores. The facility has requested a hearing on the Department’s action. A status in the case is April 16.

Blue Island Nursing Home, a 30-bed intermediate care facilities located at 2427 West 127th Street, Blue Island, has been fined $15,000 for failure to adequately supervise residents and monitor a resident’s consumption of alcohol and prevent the resident from physically abusing two other residents and a staff member. The facility requested a hearing on the Department’s action. A status in the case was held February 26 and settlement negotiations are underway.

Brother James Court, a 99-bed intermediate care facility for the developmentally disabled located at 52508 St. James Road, Springfield, has been fined $10,000 for failure to implement facility policy and procedure on Abuse and Neglect. The facility also failed to recognize the need for additional supervision of a resident after a sexual incident between two residents. The facility has requested a hearing on the Department’s action. A status in the case is March 31.

Cardinal Hill Healthcare, 90-bed skilled care facility located at 400 E. Hillview Avenue, Greenville, has been fined $55,000 for failure to provide adequate supervision to prevent a resident from choking which resulted in death. A resident took another resident’s sandwich without staff knowledge; was later found without vital signs and pronounced dead. The facility has requested a hearing on the Department’s action. A status in the case is March 31.

East Peoria Gardens Healthcare Center, a 103-bed skilled and intermediate care facility located at 1920 Springfield Road, East Peoria, has been fined for failure to provide necessary care and services to maintain health. In the case of 4 residents, the facility did not (1) perform cardio pulmonary resuscitation (CPR), (2) provide adequate supervision, and (3) monitor worsening medical condition. As a result, 3 residents died and a fourth suffered gangrene to a toe. The facility requested a hearing on the Department’s action. A hearing was held and the facility paid $32,500.

Mosaic Living Center, a 150-bed long term care facility for residents under the age of 22 located at 7464 N. Sheridan Road., Chicago, has been fined $10,000 failure to provide nursing care in accordance with a residents needs. Due to the facility’s failure to properly monitor a resident with a history of removing a feeding tube, the resident lost almost 30 pounds. The facility has requested a hearing on the Department’s action. A status conference was held February 8 and settlement negotiations are underway.

Moweaqua Nursing & Retirement Center, a 70-bed skilled care facility located at Maple and Macon Streets, Moweaqua, has been fined $50,000 for failure to supervise a resident at high risk for falls. The facility did not assess nor make changes to the plan of care for the resident, after repeated falls. As a result, the resident fell and died after suffering facial fractures and head injuries. The facility has requested a hearing on the Department’s action. A status in the case was held February 25.

Parents and Friends of the Specialized Living Center, a 100-bed intermediate care facility for the developmentally disabled located at 1450 Caseyville Avenue, Swansea, has been fined $20,000 for failure to implement a diet order for a resident at risk for choking. The facility did not monitor the resident who had received the wrong texture and consistency of food. The resident was hospitalized after choking. The facility has requested a hearing on the Department’s action. A status in the case was held February 25.

Regal Health & Rehab Center, a 143-bed skilled and intermediate care facility located at 9525 S. Mayfield, Oak Lawn, has been fined $25,000 for failure to adequately supervise four residents identified as unsafe smokers. Three of the four residents require continuous oxygen therapy. The lack of supervision resulted in one resident suffering burns to his face. The facility has requested a hearing on the Department’s action. A status in the case is March 5.

St. Anthony’s Nursing & Rehab Center, a 120-bed skilled and intermediate care facility located at 767 30th Street, Rock Island, has been fined for failure to develop and implement a plan to address a resident’s sexual behavior toward other residents. The facility also failed to implement effective interventions to monitor the resident responsible for sexually abusing two other residents. The facility requested a hearing on the Department’s action. A hearing was held and the facility paid $12,000.

Timbercreek Rehab & Health Care Center, a 202-bed skilled care facility located at 2220 State Street, Pekin, has been fined $20,000 for allowing two Certified Nursing Assistants with findings of abuse on the Health Care Worker Registry to work at the facility. The facility also failed to protect residents from abuse by one of the CNAs, who was later found to have broken the wrist of a resident. Both were terminated. The facility has requested a hearing on the Department’s action. A status in the case is March 3.

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Memory Exercises for Seniors and Caregivers

Just as exercising your body improves your muscles, exercising your brain also improves your memory capabilities, leading research shows.

A senior's 60-year-old brain will take in information two to three times slower than a 20-year old brain.  However, senior minds can learn new tricks as even older brains can grow new and stronger connections (this is why seniors who suffer strokes can effectively rehabilitate and regain their physical and mental capabilities again by retraining the brain through therapy exercises - but if they don't do the exercises, then they don't regain the movement, which why having a proactive and encouraging Caregiver is essential).

You can build your mental savings account while you are younger by continuing to involve yourself in activities which require thinking - play monopoly and scrabble, do crossword puzzles, join committees and boards which require active thinking and planning, develop new hobbies such as golf or playing a musical instrument.  And, even more important, don't stop becoming active when you retire from your day job.

Research shows you must exercise your mind regularly and be consistent (it really is the same as with physical exercise - you can't just show up and run the marathon without properly training for months).

Caregivers can bring along the crossword puzzle from the daily newspaper to do with their senior client or find a trivia book or a magazine article to discuss.  Anything that makes the mind think will work.


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